Pre-emptive infiltration of levobupivacaine is superior to at-closure administration in lumbar laminectomy patients

100 patients scheduled to undergo lumbar discectomy were randomized to have the musculus multifidi near the operated level infiltrated with levobupivacaine or a combination of levobupivacaine with steroid (methyprednisolone) at 2 different timings either before surgical incision or before wound closure. All local anaesthetic injection regimens demonstrated significantly better clinical outcomes than the saline injections for most outcome measures.The treated groups had lower parenteral opioid requirements after surgery, lower incidences of nausea, and shorter hospital stays. Furthermore, the preincision injection of levobupivacaine or levobupivacaine-methylprednisolone combination into the muscle adjacent to the operative site provided more effective analgesia than infiltration at wound closure after lumbar discectomy surgery.